Review Question - QID 106286

The patient's presentation, is most consistent with a diagnosis is ichthyosis vulgaris.

Ichthyosis is characterized by normal skin at birth that gradually progresses to very dry, scaly, "lizard"-like skin. The skin is unusually rough and dry with horny plates over the extensor surfaces of the limbs. The condition does not respond to moisturizers. The diaper area and face may be spared in children. The dryness becomes worse in the winter. Ichthyosis may be hereditary or acquired. Currently there is no cure, but treatment aims at managing the symptoms which includes using a thick moisturizer containing urea, propylene, lactic acid, glycolic acid or retinoids on the affected area.

Thyseen et al. review ichthyosis vulgaris stating that it is due to a loss of function in the filagrin gene. This results in the clinical presentation of saling, keraptosis pilaris, palmar and plantar hyperlinearity, and xerosis. The mutation occurs more frequently in Europeans and Asians and less frequently in darker-skinned individuals.

Oji and Traupe review the treatment options for ichthyosis. Currently there is no cure, but treatment aims at managing the symptoms which includes using a thick moisturizer containing urea, propylene, lactic acid, glycolic acid or retinoids on the affected area.

Figure A shows the classic "lizard" skin associated with ichthyosis.

Incorrect Answers:
Answer 2. Atopic dermatitis usually begins earlier in infancy. The face, forehead, and extensor surfaces of the limbs are usually affected. The lesions are not dry or scaling.
Answer 3. Psoriasis presents as silvery scales over the extensor surfaces of the elbows, knees, scalp, and trunk.
Answer 4. Miliaria is "sweat rash" marked by pruritic erythematous papules after heat exposure and sweating.
Answer 5. Subhorreic dermatitis is a condition marked by flakey, white to yellowish scales to form on oily areas of the skin.